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Kevin Koo: Every war brings a new medical challenge for our veterans

BY KEVIN KOO

I always look up when I arrive for work at the Veterans Affairs hospital in White River Junction. It doesn't matter whether it's an ordinary day and I'm hustling in to check on my patients before I head to the operating room, or it's a special occasion, like this past Fourth of July when the veterans got red, white, and blue t-shirts to wear over their hospital gowns.

I always look up because above the entrance hangs this banner:

"The price of freedom is visible here."

Caring for veterans is a privilege, which for me transcends the personal pride that I still profoundly feel. It's a privilege because for many people of my generation, there has been a certain distance, a kind of insulation from the realities of military conflict. We grew up long after the war in Vietnam had ended, and we were too young to understand Operations Desert Shield and Desert Storm. We do remember 9/11, of course. We remember the care packages we sent to Afghanistan and the "Support Our Troops" decals we taped on our bumpers. Still, many of us have never known what war means to those who serve or how it shapes their lives after they've retired their uniforms.

Perhaps this is why taking care of veterans feels so important to me. When I look up at the banner, I sense a call to duty and a personal commitment to the men and women whose scars bear witness to their own allegiance, months, years, often decades before. But improving the health of veterans in the 21st century extends beyond treating visible disease. Indeed, in recent years the VA has focused attention on wounds that are less obvious to the eye.

For instance, an evolving understanding of post-traumatic stress disorder and traumatic brain injury in military personnel has led to the development of robust surveillance programs and rigorous research at VA hospitals on better prevention and treatment strategies.

The progress so far is encouraging. When I look through patients' medical records, I see better mental health screening for returning soldiers, more comprehensive psychiatric care, and a growing network of veterans' support groups. An important engine behind these changes has been the systematic collection and analysis of epidemiologic data — trends, statistics, and outcomes that measure how much progress has been made. In public health, as in military tactics, intelligence forms the cornerstone of the campaign. Put another way, defining the problem is part of the solution.

Now servicemembers in Afghanistan are facing a new kind of health threat. The prevalence of improvised explosive devices and shrapnel blasts has resulted in a record number of traumatic injuries to the genitourinary organs — more than three times what was seen in Iraq. These injuries, known as "urotrauma," are especially debilitating because their impact is both visible and invisible. The physical damage to the pelvic organs is challenging to repair, and the risk to reproductive function is apparent for men and women who serve in combat roles. But the less obvious psychological effects of incontinence and infertility can be equally devastating to young veterans. The truth is, the stigmatized nature of urotrauma may have lasting consequences on a veteran's well-being and sense of identity.

As was the case with Agent Orange in Vietnam or depleted uranium during the Gulf War, I believe we share a public responsibility to provide veterans who experience urotrauma with a coordinated approach to front-line medical treatment, surgical reconstruction, and long-term care of injuries sustained in service. But to do this well, we will again need high-quality intelligence. This is why U.S. House bill HR 984, which proposes a national Task Force on Urotrauma led by the Department of Defense in collaboration with the Departments of Veterans Affairs and Health and Human Services, is an important, timely opportunity.

We know that urotrauma in veterans is underreported, understudied and undertreated; HR 984 outlines a coordinated way to identify how service members are physically and psychologically affected by these sensitive injuries and to prepare the military and VA hospitals to deliver more effective prevention and treatment.

As we honor our nation's servicemembers today, we can urge our members of Congress to join the 23 bipartisan sponsors of this bill and support the health of our newest returning veterans. And as we, as a community, reflect on the visible price of freedom, I am reminded that the wounds we cannot see are often the ones we need most to heal.

Kevin Koo of Lebanon is a resident physician in urology at Dartmouth-Hitchcock Medical Center in Lebanon and the White River Junction, Vt., VA Medical Center.